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General NPI Number Information
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NPI Number | 1477363794
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Entity Type | Individual
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Provider Name | TIMOTHY AUSTIN GUOLI LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1530 N 7TH ST STE 201
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1061
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Country | US
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Telephone | 812-238-7631
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Fax |
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Provider Business Mailing Address
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Address Line | 6619 BROTHERHOOD WAY
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City | FORT WAYNE
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State | IN
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Zip | 46825-4226
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Country | US
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Telephone | 260-426-0420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39005134A
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License Number State | IN
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